Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH - pg.2 | allnurses

Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH - page 2

The biggest was NOT getting catheters out as soon as possible. If the doctor doesn't address it then the nurse should ask if there are any reasons the patient still needs the catheter. If not ask for... Read More

  1. Visit  nursemarion profile page
    1
    I am a QI nurse in home health and am looking at improving this outcome in our 2010 project year. It is a tough outcome. Glad to hear you had results, and your ideas are good ones. Thanks for sharing. Long term foleys are an endless source of frustration for all of us, and the poor patient who has recurrent UTIs must suffer terribly. I often see staff plop the bag on the patient's lap when transferring from chair to bed, etc. Especially in PCH settings. I think teaching the staff in these facilities will definitely be a part of my plan. Your patients are lucky that you are so motivated. Great work!

    BTW we have been suggesting patients keep the bag in their hospital plastic basin or a clean bucket for ages. At home there is no one to keep an eye on them and they often end up leaking since the caths and bags are only changed monthly. Home beds also have no siderails usually, so they either jerry rig (sp?) a hanger, or hook them on the footboard post (hard to reach). Hence the basin.
    Last edit by nursemarion on Sep 16, '09
    deskbarn likes this.
  2. Visit  HazeKomp profile page
    0
    Is there a non-offensive way to re-teach and reevaluate how experienced nurses place foley catheters? On occasion I just happen to be at a bedside when another RN is placing a foley...and am appalled at their technique, or lack thereof! They often have poor exposure of the urethra, often contaminate the area by relaxing their "exposing" fingertips between each betadine wipe, and let go of the labia when advancing the catheter thereby contaminating the catheter.

    I have to work closely with these folks, and I am FAR from a perfect nurse... BUT I have very, very meticulous about my catheter insertion technique.

    Any hints?
  3. Visit  champion#1 profile page
    0
    maggie

    Thanks, for this information. I am the nurse educator for a LTACH facility. What a wonderful idea to empower staff in helping to prevent FRUTI. I am going to pass this information to our infection control nurse as well. We use the Low Boy beds for our high fall risk patients also. It is a challenge to prevent FRUTIs. I applaud your efforts and keep up the good work.

    Wen-Wen
  4. Visit  nursemarion profile page
    1
    Quote from HazeKomp
    Is there a non-offensive way to re-teach and reevaluate how experienced nurses place foley catheters? On occasion I just happen to be at a bedside when another RN is placing a foley...and am appalled at their technique, or lack thereof! They often have poor exposure of the urethra, often contaminate the area by relaxing their "exposing" fingertips between each betadine wipe, and let go of the labia when advancing the catheter thereby contaminating the catheter.

    I have to work closely with these folks, and I am FAR from a perfect nurse... BUT I have very, very meticulous about my catheter insertion technique.

    Any hints?
    If you are a staff nurse, you must involve infection control in this. If it comes from you they will see you as a threat and a know it all. I suggest a general review of the techniques for everybody - maybe a video from the local nursing school or something? I am sure there is information out there. Then, have the staff do competency testing. It is going to be offensive no matter what but we all forget things and need a review sometimes. If it comes from the infection control dept. as a "project" it will be better accepted. In the name of QI or education nurses will at least understand why.
    deskbarn likes this.
  5. Visit  guniwan profile page
    0
    Great idea to share maggiejrn. Kudos given
  6. Visit  Cyn2school profile page
    0
    I was a Special Education teacher who used motivators like tickets/trinkets for my students with mental retardation and Autism. I think a better buy in would be evidence based education presented @ informal in services with ceu units offered for CNA's. Skip the tickets and treat the CNA's and your peers like the health professionals they are.
  7. Visit  paul cloonan profile page
    1
    Thanks you, great article. We were having the same problems with the Foley bag touching the floor when the bed was in the lowest position also. What I had maintenance apply was hooks on the foot boards, which maintained the gravity for drainage and kept the Foley bags off the floors. We used the 3M self adhesive hooks. It was your article that inspired this. Thanks
    deskbarn likes this.
  8. Visit  goodneighbor profile page
    0
    Thanks! I think the idea to place the bag inside one of those pink buckets is wonderful. It is true that low beds make it almost impossible to hang a bag. I also like the idea of using an alcohol wipe after emptying the bag. Tell me this.. I worked at a place that advocated "changing the bag" once a month (for those who had permanent catheters). This sounds like you are breaking a sterile field, although on the other hand it does seem like it cannot stay there forever. It was a LTC and patients had their foleys for months. My Lewis says dont break a sterile field. What is current best practice?
  9. Visit  cory39 profile page
    0
    Wow, this post amazes me. For one, I cannot believe that nurses were allowing the catheters to be higher than the bladder, just to keep them off the floor. Where are your critical thinking skills? Two, it is a closed system, and I highly doubt that you were getting your infections from having the bag touch a floor. What does the bag touch when you hang it? Or put it anywhere else for that matter? I find it absolutely ridiculous that you would think infections are happening this way. You might want to focus your energy on training your staff to clean around the catheters and I would also look into starting a protocol where nurses can remove foleys without a doctors order if certain criteria is met. Most infections come from having them in for to long.
    If your not part of the answer, your part of the problem. In this instance, I would have to say that your part of the problem :spin:
  10. Visit  tcroc profile page
    1
    This article was very helpful to me. I am a student nurse, and I am currently in clinical at a LTC facility. I have a patient that has a foley that stays in, and is always getting UTI's. Its mostly because the cna's that turn him aren't using proper technique. Twice Ive seen them raise the bag over patient to the other side of bed, and once I found it on the bed next to him! It frequently is touching the floor, and Ive told the RN on the floor about teaching the cna's. I am only there 2 days a week, I cant imagine what is happening when I am not there. I like the idea to use a disposable wash tub.
    thanks
    PS to cory39, the first thing I learned was that the floor of a facility is the dirtiest place ever, never touch it! never touch anything that has touched it! I place the soles of my shoes in a 1:10 bleach solution every night! They never go inside my house! If the port on a foley bag touches the floor, believe me infection is possible!!
    deskbarn likes this.
  11. Visit  cory39 profile page
    0
    TCROC, if you like the idea of the disposable wash tub, how is that different than the bottom of the catheter touching anything else? None of what the bag touches is even close to being sterile so you cannot possibly say that it is the floor that is causing the infections. When the port opens, urine flows out and down, not up and in. When the port is closed, it's closed and sealed off. So you need to make up your mind on where you say the infections are coming from. Is it because of the CNA's that are turning the pt? Is it because the foley bag is on the bed next to him? Or is it because your only there 2 days and therefore the pt. could not possibly be getting the right care? Sounds like to me that pt. has had a foley catheter in for way to long and THAT my dear is the source of your UTI's, NOT because the bag was touching the floor, NOT because the CNA's were turning him wrong, NOT because the bag is on the bed.
    The point I'm trying to make is that if you are going to say that the cause of the infections is because the bag touches the floor, then you also have to say that the bag cannot touch ANYTHING else that is not sterile. And another thing, your probably not in a position where you can be telling the nurses that work there how to do their job.
    Last edit by dianah on Dec 10, '09 : Reason: TOS
  12. Visit  tcroc profile page
    0
    Im not saying that only the floor is causing the infections, however I was taught to clean the port after emptying it from residual urine. If the port is not clean then yes it is possible that bacteria will grow, we know bacteria love moist and warm environments. So it is possible that the floor could cause infection. My patient has BPH and a catheter must be in place for long periods of time. And since I am working under my instructors liscense, it is my responsibility and my obligation to report any wrong doing to the nurse on the floor. If I dont tell them , I am just as wrong. I will always do what is right, and if that means telling them how to do their job when it is obvious that something is wrong, then that is what I will do. I think about the patients safety first!! Remember the oath my dear.
  13. Visit  cory39 profile page
    0
    I understand what your saying and I also understand that the floor is not necessarily the cleanest place. Believe me, I understand where you are coming from and understand your concern, however I believe you are probably barking up the wrong tree. If they are turning their pt. from side to side how do you propose they get the bag over to the other side of the bed? And whether or not your pt. has BPH or needs the catheter to protect his skin, the fact of the matter remains that the catheter is there. Those catheter drainage systems are closed drainage systems, which are suppose to prevent the very thing your talking about. Now, having said that, are they 100% effective? My guess would be 99 point something, something, something that they are. I have not seen any evidence where it says they are not effective. The point I am trying to get across to you is that the chances of getting a UTI form having the bag touch the floor are very very very low (probably 0) compared to all the other ways that are probably at play here. And I seriously doubt it is because the way they are turning the pt.
    I have worked on a surgery floor for 7 years and I have seen and dealt with catheters many, many times. I could probably put one in with my eyes closed. Instead of spinning your wheels about the bag touching the floor I think I would be more concerned about how long the catheter has been in place first, and probably the next area I would lean towards would be the hygeine care that the pt. is getting (or not getting in this case), and also the aseptic technique that they are using when putting the catheter in.
    I certainly do not disagree with you "cleaning the port off," as I feel it surely could not hurt. Personally, I have never seen that done in the many years I have been in this profession, but if you feel that helps, then go for it. Fact of the matter remains is that if your saying the bag touching the floor causes infections, then you need to go ahead and say that if the bag touches the IV pole, bed frame, or chair then that will also cause infection. Although the floor is dirty, I don't know how you can say it has any more bacteria than anything else the bag touches. This whole post started with an "educator" saying she was on some crusade to stop UTI's caused by the bag touching the floor. I'm sorry, but I have major concerns with people that are trying to fix something that they think is the cause, but yet they are overlooking the most obvious causes of all. Probably because it's just the easier path to take. Especailly when they are supposedly educators in the first place. I have seen many people over the years in this profession that make up stupid and senseless policys when they have never stepped foot on a nursing floor and done direct pt. care.
    One last point, when your emptying the bag, your not emptying "residual" urine. Residual urine is urine that is still left in the bladder after the pt. has voided.


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